Provider Demographics
NPI:1598317117
Name:WHIPPLE, DEVIN TALMAGE (OD)
Entity Type:Individual
Prefix:
First Name:DEVIN
Middle Name:TALMAGE
Last Name:WHIPPLE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1356 S GILBERT RD
Mailing Address - Street 2:STE 3
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85204-6077
Mailing Address - Country:US
Mailing Address - Phone:480-545-8985
Mailing Address - Fax:480-545-9384
Practice Address - Street 1:15465 W MCDOWELL RD STE 101
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-2528
Practice Address - Country:US
Practice Address - Phone:623-247-2706
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-13
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOPT-002362152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist